ovarian follicle size

Over many years and cycles I have developed a series of informal rules for IVF in order to protect me from me. These are simply things that I do or do not do in order to remain emotionally sound and balanced as I navigate this challenging process. Last night I not only broke one of my rules, I completely anhialated it. And it was one of the most sacred rules I attempt to follow.

I cruised into Grand Rapids early enough to find a delicious organic and gluten-free friendly restaurant and had an amazing meal. After my sweet potato and quinoa burger I was anxious to get back to the hotel and take advantage of some “Mommy time.” I had big plans to blog my little heart out.

But I didn’t write a word. Not one single word.

Why?

As soon as I opened my Macbook I lost all self control and proceeded to spend the entire evening with my old friend Dr. Google. I was frantically seeking reassurance the cramping and bleeding from Thursday night wasn’t going to delay our transfer.

As is always the case, all I found was more reason to worry. Since it was late Friday night and I was all alone, I had no doctor to calm my fears. There was no husband to tell me to shut the computer, calm down, and go to bed. I was up past midnight, which is kind of tough for an old lady with a 6:30 AM injection and a 7:30 AM ultrasound.

And to think when I checked into the hotel I was worried the busloads of teenage girls in town for a big volleyball tournament would keep me up late.

I bet I outlasted them all.

No matter what the situation, spending too much time with Dr. Google is never a good thing. I am the first underscore the importance of educating yourself and being your own advocate in all things fertility related. It is critical to research and question your clinic’s plans, but only within reason. There is a distinct difference in learning about a process and relentlessly searching the internet in an attempt to find answers.

What I found last night was unsettling. There was a dearth of information of using cytotec prior to embryo transfer, but the data available about cervical dilation prior to embryo transfer made it very clear that the procedure should occur a month to three months in advance of the procedure. Pregnancy outcomes when a cervix is dilated too close to transfer drop to almost nil. One study had a 0% pregnancy rate for cervical dilation at embryo retrieval. Another study had a 2.5% pregnancy rate for cervical dilation two days prior to transfer.

Our transfer should happen sometime next week, a measly 5 to 7 days from taking the cytotec.

Cue major freak out and sleepless night.

Needless to say I was anxious to see the doctor today. In fact I practically accosted him when he entered the exam room. I don’t think I even said hello prior to telling him about the bleeding and hysterically citing all the studies that stole my shut eye.

Turns out, the doctor knew all about the studies. In fact he knew a lot about them that I didn’t know, like the essential fact that the cervical dilation referenced in the studies is a stretching of the cervix that happens under anesthesia and creates trauma that needs to heal prior to a successful transfer. The cytotec that we used has a very short half life and did not actually dilate my cervix, it only softened it.

Most importantly, the ultrasound showed a uterus with the correct triple pattern measuring at 10mm. This is absolutely perfect for this stage of IVF. We could even see on the ultrasound that the bleeding I experienced had come from the cervix and that we could expect a little more over the next few days as it clears up.

Everything was perfectly normal and exactly as it should be.

I was worrying over nothing, as I seem to do when my estrogen begins to approach 2000. I always get a little bit crazy at this stage of stimulation. While being so close to retrieval is exciting, its a lot to manage when your body is processing all the hormones as well as physical distortion and discomfort from enlarged ovaries full of follicles.

Speaking of follicles, would you believe they are the exact same size as two days ago? The meds are still working, its just that my clinic measures differently than the local hospital that monitors me closer to home. According to the doctor its not uncommon to have a 2mm difference with a different machine and user which is why they have me travel the three plus hours for monitoring as we get close to time for retrieval. My largest follicle is still 17.5mm which means we have a little more time than I thought.

I have another ultrasound at the clinic Monday morning to confirm, but it looks like we are back to the original plan of triggering Monday night, retrieving the eggs on Wednesday, and transferring on Friday.

So today was another inspiring distress eliminating appointment, especially since the left ovary seems to be producing a few more follicles large enough to give us eggs. I am not sure how many good follicles we have though, because in all the excitement and desire to resolve my cervical dilation fears I completely forgot to ask about the number of follicles and my estradiol level.

But its okay. I don’t need to know all the details. Really, I don’t. Last night was a reminder that sometimes its good to put a little faith in your doctor and take a break from questions and data. Besides, after tonight I am only one lonely night in a hotel room away from getting a final pre-retrieval count Monday morning.